At Mount Sinai, telehealth reduces ER visits and hospitalizations

At the hospital's inflammatory bowel disease center, providers can now deliver better care to patients with delicate conditions.

The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital had been relying on traditional office visits to connect with patients.

THE PROBLEM

These visits present patients with several barriers to care, however, including the inconvenience of travel and time off from work or school to visit their doctor.

"Our patient population has chronic digestive disorders and so diarrhea and abdominal pain often prohibit them from making appointments at the last minute," said Laurie Keefer, health psychologist and director of subspecialty medical home, GRITT-IBD, The Susan and Leonard Feinstein Inflammatory Bowel Disease Clinical Center at Mount Sinai Hospital.

"Many patients do not live near the medical center and some are college students who can only visit when they are home with their families over the holidays or summer break," she said.

Patients need frequent interaction with their doctors – including the team of practitioners that knows their history and unique needs – and their health relies on staying connected. With traditional visits as the only method to connect with their doctor, patient needs can go untreated, they may suffer needlessly, or experience worsening medical conditions while waiting until their next scheduled office visit.

PROPOSAL

So the center decided to launch a telemedicine program, with the help of MediSprout, a telehealth technology vendor. Specifically, MediSprout's V2MD, a HIPAA-compliant video conferencing technology for telemedicine visits.

The technology provides teleconferencing via the V2MD app accessed from a smartphone or computer, allowing patients to meet with center doctors and healthcare providers from the convenience of their home or office.

"The vendor promised to resolve our problem of keeping consistent connection with our patients by making it easy for patients to meet with us between regular visits – on their own timetable, from wherever they choose," Keefer explained. "It is also for provider burnout because patients can be seen from the provider's place of choice as well."

The telemedicine technology provides the center with a means of convenient face-to-face interaction with its patients, making it easy for the center's providers to stay on top of patient needs, provide guidance, and make revisions to their care before their chronic condition reaches crisis stage, Keefer said.

Patients are better able to manage their conditions when they feel better connected to the center and know that they can reliably and easily access their caregivers with questions or concerns, she added.

MARKETPLACE

There are many vendors on the market today offering telemedicine technology, including American Well, Avizia, GlobalMed, MDLive, Novotalk, SnapMD, Teladoc, TeleHealth Services, Tellus and Tyto Care.

MEETING THE CHALLENGE

Mount Sinai uses the V2MD telemedicine app with patients in the inflammatory bowel disease center, including a patient-centered subspecialty group known as GRITT-IBD (Gaining Resilience Through Transitions) for high-complexity IBD patients, at Mount Sinai Hospital in New York City.

"Many of our patients have inflammatory bowel disease conditions that require real-time support and care from a number of medical providers, including physicians, nutritionists, pharmacists, ostomy care, nurse practitioners, psychologists and social services," Keefer explained.

"Unlike some other health IT, telemedicine is patient-focused and facilitates care rather than stands in the way of it."

Laurie Keefer, Mount Sinai Hospital

"As a health psychologist and director of the group, I use MediSprout to provide psychological care, such as cognitive-behavior therapy, gut-directed hypnotherapy, and resilience training to patients managing inflammatory bowel disease conditions," she said.

Other practitioners at the center use the technology to manage other inflammatory bowel disease patient needs, including medication changes or concerns over side effects, advice on nutrition and diet, and to provide injection training.

Mount Sinai has found that the telehealth technology is reliable – solid operability and connection are critical to establishing a trustworthy patient-doctor relationship and especially important when conducting treatments, such as hypnosis, Keefer stated.

"It's also user-friendly for both healthcare providers and patients, regardless of the user's level of tech savvy," she said. "Additionally, the technology makes it simple to incorporate tele-visits into patient healthcare records and also to generate reports for hospital administration."

RESULTS

Since implementing the telehealth technology, the center has conducted more than 700 tele-visits with about half of the inflammatory bowel disease clinic's 5,000 patients and about 40 percent of the center's highest risk patients who account for 20 percent of the practice.

"We have seen that the more tele-visits to have with our patients, the less likely they are to visit the emergency department or be hospitalized for care," Keefer said. "This drastically reduces healthcare costs, as an average hospitalization can cost $50,000.

"Instead of a patient heading to an ER when their symptoms reach crisis level or they are unable to visit their doctor and do not know where else to turn, they can conduct a tele-visit with a provider at the clinic who knows their history and condition and can recommend next steps," she explained.

ADVICE FOR OTHERS

Telemedicine can be easily implemented and quickly integrated into a practice, Keefer said.

"It enables healthcare providers to provide a reliable continuum of care to their patients by helping them stay connected, conveniently," she advised. "Tele-visits can be done when it works for both, including after-hours when patients sometimes need us most. Unlike some other health IT, telemedicine is patient-focused and facilitates care rather than stands in the way of it."

Because of telehealth, the center is able to better know its patients, Keefer concluded, and to help them manage their chronic conditions, ultimately improving their quality of life.